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PSA – TO TEST OR NOT TO TEST, WHOSE DECISION IS IT?

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By: Suzanne CM Mcdonough

508-821-4324

According to the CDC, prostate cancer is the second most common cancer among men in the United States. Nearly 30,000 men in the United States die from prostate cancer each year.

While only biopsy can actually diagnose prostate cancer, a simple screening blood test  – PSA – can be done to determine whether a man may have the disease.  Armed with this information, a man with an elevated PSA can consult with a specialist – generally a urologist – and can decide whether to have a biopsy or other testing.

Annual PSA testing has been recommended for men starting at age 50.  Some organizations have recommended that higher risk men, including African American men and men whose father or brother had prostate cancer, begin screening at age 40 or 45.  A normal PSA level is less than 4, although in certain circumstances, the cutoff is lower.

Whether or not to perform PSA testing has become controversial.  Insurers and some physicians argue that PSA elevations can be caused by conditions other than cancer, biopsy is not risk-free, and diagnosis does not necessarily change the outcome.  Others argue that early detection of prostate cancer can cure or at least provide a better opportunity for cure.

Clearly, the decision to have a PSA test and, if indicated a prostate biopsy is a serious matter.  It is a decision to be made by a patient after a full discussion with his physician about the risks and benefits and the possible alternatives. It is not a decision to be made for a patient by a doctor, but rather a decision to be made by the patient with the doctor.

This summer, Keches Law Group settled a prostate cancer case for $750,000.  In this case, the treating specialist, the urologist, opted not to perform prostate biopsy in a 51 year old man whose PSA levels were elevated to begin with, and continued to rise during the two years that the urologist followed him. The end result was that the prostate tumor grew to a large size and spread outside of the prostate gland – making the cancer incurable.  The failure to biopsy will likely result in this patient’s death from prostate cancer.

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